Performing a tarsorrhaphy.

Tarsorrhaphy is the joining of part or all of the upper and lower eyelids so as to partially or completely close the eye. Temporary tarsorrhaphies are used to help the cornea heal or to protect the cornea during a short period of exposure or disease. Permanent tarsorraphies are used to permanently protect the cornea from a long-term risk of damage. A permanent tarsorrhaphy usually only closes the lateral (outer) eyelids, so that the patient can still see through the central opening and the eye can still be examined

Bilateral Extraocular Muscle Metastases from Breast Cancer in a Patient with Thyroid Eye Disease

Introduction: Breast cancer is a very rare cause of bilateral extraocular muscle metastasis. Extraocular metastasis can be missed in patients with concurrent orbital pathology.Presentation of Case: We present a further case of a 71-year-old lady with concurrent thyroid eye disease. She initially presented with bilateral restriction of extraocular movements before developing unilateral ptosis and visual reduction. An extraocular muscle biopsy confirmed metastatic lobular breast carcinoma.Conclusion: This case adds to the literature base on extra-ocular muscle metastasis and highlights the importance of maintaining a high index of suspicion particularly in the presence of co-existing orbital pathology.  We also review the other cases in the literature and the differences in clinico-radiological presentation of thyroid eye disease and extraocular muscle metastases

Eyelash inversion in epiblepharon: Is it caused by redundant skin?

Purpose: To evaluate the effect of redundant lower eyelid skin on the eyelash direction in epiblepharon. Materials and methods: Asian patients with epiblepharon participated in this study. The lower eyelid skin was pulled downward in the upright position with the extent just to detach from eyelash roots, and the direction of the eyelashes was examined. These evaluations were repeated before surgery while the patients were lying supine under general anesthesia. Results: The study included 41 lower eyelids of 25 patients (17 females, 8 males, average age; 5.6 years, 16 cases bilateral, 9 unilateral). In the upright position, without downward traction of the skin, the eyelashes were vertically positioned and touching the cornea. The redundant skin touched only the eyelash roots and had minimal contribution to eyelash inversion. With downward skin traction, there was no signifi cant change in the eyelash direction. In the spine position, the eyelashes were touching the cornea, and there was marked redundant skin that was pushing the eyelashes inward. With downward skin traction, there was no significant change. Conclusions: The direction of lower eyelashes in patients with epiblepharon was less infl uenced by lower eyelid skin redundancy than previously considered. The redundant skin is only a possible aggravating factor to epiblepharon.Hirohiko Kakizaki, Igal Leibovitch,Yasuhiro Takahashi and Dinesh Selv

Absence of lateral palpebral raphe in Caucasians

Classical anatomical teaching reports the presence of the lateral palpebral raphe formed at the union in the preseptal and orbital parts of the orbicularis oculi muscle, or by the tendon adhering these to the underlying zygomatic bone. The lateral palpebral raphe has been shown to be absent in Asian cadavers. The current study uses both evidence from the anatomical dissection of five eyelids from three Caucasian cadavers, and histological assessment of the lateral canthus of 13 eyelids from seven Caucasian cadavers to illustrate the absence of the lateral palpebral raphe in Caucasian population

Overriding of the preseptal orbicularis oculi muscle in Caucasian cadavers

We aimed to microscopically examine whether Caucasian eyelids demonstrate overriding of preseptal orbicularis oculi muscle (OOM) over the pretarsal OOM in both lower and upper eyelids. Full thickness sections of 13 lower eyelids and 11 upper eyelids from seven Caucasian cadavers were examined. In the lower eyelids, all 13 specimens demonstrated clear overriding of preseptal OOM over the pretarsal OOM. The overriding part extended almost to the level of lower eyelid margin. However, in the upper eyelids, only one of the 11 eyelids demonstrated overriding, and the overriding part only extended to the level of mid-tarsal plate. Our result strongly supports the hypothesis of overriding of the preseptal OOM over the pretarsal OOM as an etiology of involutional lower eyelid entropion. The relatively low frequency of upper eyelid overriding preseptal OOM in our study reflects and may explain the rare occurrence of involutional upper eyelid entropion

Lacrimal Gland Involvement in Lymphomatoid Granulomatosis and Review of the Literature

Objective. To describe the clinicoradiological and histopathological findings in a case of lacrimal gland enlargement secondary to lymphomatoid granulomatosis (LG) and to review the literature. Design. Case report and systematic literature review. Methods. A 75-year-old woman presented with right ptosis. Computerised tomography showed lacrimal gland enlargement, and biopsy done was inconclusive. She subsequently developed pulmonary symptoms and underwent transbronchial biopsy that was diagnosed as LG. Pub Med and OVID databases were searched using the term “orbit/eye involvement in lymphomatoid granulomatosis”. Articles that predated the databases were gathered from current references. Results. The patient underwent lacrimal gland biopsy which revealed necrotic and inflamed tissue with no further categorisation but transbronchial biopsy helped in establishing the diagnosis of LG. On initiation of prednisolone and cyclophosphamide, her orbital lesion resolved but the patient died following massive pulmonary hemorrhage within a month of diagnosis. Conclusion. Ophthalmic involvement in LG is very rare. Varied presentations are due to central nervous system involvement, vasculitis, or infiltration of ocular or orbital structures. LG is an angiocentric and angiodestructive granulomatous disorder and can involve any tissue, thus accounting for the variable presentations reported in literature

The importance of rim removal in deep lateral orbital wall decompression

Purpose: To evaluate the surgical outcome of deep lateral orbital decompression with or without rim removal. Design: Retrospective case series. Methods: Thirty-two patients (47 orbits) with Graves’ orbitopathy who underwent simple deep lateral decompression or balanced lateral plus medial decompression. Of the 14 patients (24 orbits) who underwent simple deep lateral decompression, 8 (13 orbits) had temporary rim removal and in 6 (11 orbits) the rim was left intact. Of the 18 patients (23 orbits) who underwent a balanced decompression, 7 (9 orbits) had temporary rim removal and in 11 (14 orbits) the rim was left intact. The amount of postoperative reduction in proptosis was compared among these four groups. Results: The average reduction in proptosis in the simple deep lateral decompression group was 5.73 mm (range: 4.0–8.0 mm) in the rim removal group and 4.09 mm (range: 2.5–6.0 mm) in the intact rim group (P = 0.005). The average reduction in proptosis in the balanced decompression group was 6.39 mm (range: 5.0–8.5 mm) in the rim removal group and 5.07 mm (range: 3.0–8.0 mm) in the intact rim group (P = 0.039). There was no statistically significant difference in proptosis reduction between the simple deep lateral decompression with rim removal group and the balanced decompression with an intact rim group (P = 0.220). Conclusion: The rim removal approach allows a more effective decompression than the intact rim approach. Simple deep lateral decompression with rim removal approach has a similar effect to balanced decompression through an intact rim.Kakizaki H, Takahashi Y, Ichinose A, Iwaki M, Selva D and Leibovitch

Double motion of upper eyelids in Graves’ orbitopathy: an additional sign for detection of thyroid dysfunction or positive thyroid autoantibodies

Purpose: To assess the effectiveness of the upper eyelid double motion sign in Graves’ orbitopathy (GO) in detecting thyroid dysfunction or a positive level of thyroid-related autoantibodies. Methods: GO was defined when more than two GO-related eyelid symptoms, including the double motion sign, existed with at least one positive thyroid-related blood test. Blood tests were performed in patients with more than two GO-related eyelid symptoms. The double motion was defined when the upper eyelid stopped at least once during downward eye movement. Fifty patients without GO or other eyelid diseases were used as controls. Results: There were 353 patients who showed more than two GO-related eyelid symptoms including the upper eyelid double motion sign. Of these, 300 patients were diagnosed with GO (300/353, 85.0%). The double motion sign was demonstrated in 267 patients (75.6%). A pause in double motion was typically seen around the anterosuperior direction of gaze. Double motion was not seen in any of the control eyelids. Although only 7.0% were hyperthyroid and 8.6% were hypothyroid, thyroid related autoantibodies were shown in 73.9% of patients. When the double motion sign was removed from the diagnostic criteria of GO, 263 patients had more than two thyroid-related eyelid symptoms, including 223 patients diagnosed as GO (25.7% reduction), although the rate of a correct diagnosis was almost the same (84.8%). Conclusions: The double motion sign of the upper eyelids is frequently demonstrated in GO patients. This previously unreported sign can help in detecting thyroid dysfunction states with positive levels of autoantibodies.Hirohiko Kakizaki, Yasuhiro Takahashi, Masayoshi Iwaki, Akihiro Ichinose, Dinesh Selva, Igal Leibovitc

Recovery of Visual Function in a Patient with an Onodi Cell Mucocele Compressive Optic Neuropathy Who Had a 5-Week Interval between Onset and Surgical Intervention: A Case Report

Purpose. To report on a patient with compressive optic neuropathy secondary to an Onodi cell mucocele, who fully recovered visual function following surgery. Method. Case report. Results. A 28-year-old male was admitted with a right visual acuity of 20/100 following treatment for an initial diagnosis of optic neuritis. Subsequent examination suggested compressive optic neuropathy, and neuroimaging confirmed the presence of an Onodi mucocele compressing the optic nerve. The patient underwent a right endonasal sphenoethmoidectomy with decompression 5 weeks after the initial onset of symptoms. Three weeks following surgery, the visual acuity was 20/20, and there was complete resolution of the visual field defect, which has remained stable at 1 year. Conclusion. Onodi cell mucocele should be included in the differential diagnosis of a young patient with compressive optic neuropathy. Surgical decompression should be considered even when symptoms have been present for over a month

Case Report Recovery of Visual Function in a Patient with an Onodi Cell Mucocele Compressive Optic Neuropathy Who Had a 5-Week Interval between Onset and Surgical Intervention: A Case Report

. Purpose. To report on a patient with compressive optic neuropathy secondary to an Onodi cell mucocele, who fully recovered visual function following surgery. Method. Case report. Results. A 28-year-old male was admitted with a right visual acuity of 20/100 following treatment for an initial diagnosis of optic neuritis. Subsequent examination suggested compressive optic neuropathy, and neuroimaging confirmed the presence of an Onodi mucocele compressing the optic nerve. The patient underwent a right endonasal sphenoethmoidectomy with decompression 5 weeks after the initial onset of symptoms. Three weeks following surgery, the visual acuity was 20/20, and there was complete resolution of the visual field defect, which has remained stable at 1 year. Conclusion. Onodi cell mucocele should be included in the differential diagnosis of a young patient with compressive optic neuropathy. Surgical decompression should be considered even when symptoms have been present for over a month